A nurse is providing care after auscultating a client's breath sounds. Which assessment finding is correctly matched to the nurse's primary intervention?

Correct Answer: C

Rationale: The correct answer is C because wheezes indicate narrowing of airways, requiring bronchodilation. Step 1: Identify the assessment finding (wheezes). Step 2: Understand that wheezes indicate airway constriction. Step 3: Appropriately intervene by administering a bronchodilator to dilate the airways and improve breathing. Other choices are incorrect because: A: Increasing oxygen flow rate does not address airway constriction. B: Encouraging coughing for crackles does not address airway narrowing. D: Deep breathing for vesicular sounds does not target airway constriction.

Correct Answer: C

Rationale: Emphysema is the correct answer because it is a non-reversible pulmonary disease characterized by the destruction of lung tissue, leading to the blockage of bronchioles and rupture of alveoli. This results in difficulty breathing and reduced oxygen exchange. Silicosis (A) is caused by inhaling silica dust, not related to bronchial blockage. Asphyxia (B) is a condition of suffocation, not related to pulmonary disease. Embolism (D) is the blockage of a blood vessel by a clot, not specific to the bronchi or alveoli.

Correct Answer: B

Rationale: The correct answer is B: The tonsils help to guard the body from invasion of organisms. Tonsils are part of the immune system and act as the body's first line of defense against bacteria and viruses that enter through the mouth and nose. They help to trap and kill these pathogens, preventing them from causing infections in the body. This function is essential for overall immune response and protection against illnesses. Explanation for why the other choices are incorrect: A: The tonsils do not separate the windpipe from the throat. That function is performed by the epiglottis. C: Tonsils do not make enzymes for digestion. Enzymes for digestion are mainly produced by the pancreas and salivary glands. D: Tonsils do not regulate airflow into the lungs. The epiglottis and other structures in the respiratory system are responsible for regulating airflow.

Correct Answer: D

Rationale: The correct answer is D: It lubricates the movement of the thorax and lungs. Pleural fluid acts as a lubricant between the layers of the pleura, reducing friction and allowing smooth movement during respiration. This function is crucial for the efficient expansion and contraction of the lungs during breathing. Explanation: 1. A (It allows for full expansion of the lungs within the thoracic cavity): While pleural fluid does contribute to lung expansion, its main role is not to solely allow for full expansion. 2. B (It prevents the lungs from collapsing within the thoracic cavity): This is incorrect as the pleural pressure, rather than the pleural fluid, prevents lung collapse. 3. C (It limits lung expansion within the thoracic cavity): This is incorrect as pleural fluid actually facilitates lung expansion by reducing friction.

Correct Answer: A

Rationale: Step 1: The upper respiratory system requires protection and mucus secretion. Step 2: Pseudostratified epithelium provides protection and has cilia for moving mucus. Step 3: Ciliated columnar cells help sweep mucus and debris out of the respiratory tract. Step 4: Therefore, pseudostratified ciliated columnar epithelium is the correct choice. Summary: B: Moist cuboidal epithelium lacks cilia and isn't specialized for mucus clearance. C: Simple squamous epithelium is too thin and fragile for protection. D: Stratified squamous epithelium is more suited for areas with high mechanical stress.